What You Might Not Know About Double Mastectomy

Fighting and preventing breast cancer is a personal decision, especially when considering bilateral (double) mastectomy, the complete removal of both breast tissues. Mattie Testroet, ARNP, UnityPoint Health, answers questions surrounding double mastectomy, including what you might not know about the procedure.

Can anyone fighting breast cancer have a double mastectomy?

Yes. Most patients have a choice whether to have a lumpectomy or mastectomy. Some patients will choose mastectomy to avoid radiation treatment, further biopsies and imaging (mammogram). Other women who are at high-risk, especially those who are BRCA1 or BRCA2 gene positive, often consider prophylactic mastectomy – or choosing to have the surgery based on risk factors before breast cancer has a chance to develop.

In many cases, women with a family history of breast cancer can choose to have a double mastectomy, although insurance can be picky about who is and isn’t approved. Those with a first degree relative, mother, sister or daughter, who was diagnosed before the age of 50 may consider bilateral mastectomy.

When should double mastectomy be considered as a treatment plan?

Ultimately, it’s personal preference for the individual. Prophylactic mastectomy should always be considered in persons who are BRCA1 or BRCA2 positive, due to their high risk of both breast and ovarian cancer. If women have a large tumor, more than one tumor, history of chest radiation (before age 30) or are pregnant, bilateral mastectomy can always be considered.

Is a double mastectomy one surgery?

Normally, the double mastectomy itself is only one surgery. But, some women may choose to have reconstruction at the same time, while others will choose to wait. Double mastectomy reconstruction may include multiple surgeries and/or procedures, depending on what is recommended.

Can the nipple be saved in a mastectomy?

Many surgeons will now perform nipple-sparing mastectomy (NSM). This is performed similar to a mastectomy, but the breast skin envelope and nipple are left intact. Also, some tattoo artists are now performing 3D nipple tattooing for mastectomy. This is often done three to four months after reconstruction. The artist uses pigment to recreate an image of a natural nipple on the breast skin.

Are chemotherapy and radiation needed with a double mastectomy?

Often times, no. Many women choose mastectomy to avoid radiation. However, that's not always an option, and women should talk with their doctors or care team before finalizing their decisions. There are cases where women will receive chemotherapy therapy before the surgery (neoadjuvant) or after surgery (adjuvant). If a woman’s risk score is low, some will need only hormone therapy or observation following mastectomy.

What are the risks of having a double mastectomy?

The risks for mastectomy are similar to any other type of surgery. Common complications include phantom breast syndrome (the sensation of breast tissue still being present, sometimes with pain), collection of fluid under the skin (seroma), wound infection, skin flap necrosis and pain. Some women also have arm swelling, pain, numbness and lymphedema (swelling caused by blockage in lymph nodes). But, infection rates after breast surgery are relatively low, at around three percent. Antibiotics are often given before the procedure, and double mastectomy is performed under general anesthesia.

Can you still get breast cancer after a double mastectomy?

In women who are BRCA1 or BRCA2 positive, studies have shown around a 90 percent decreased risk of developing breast cancer in the future. For women who undergo mastectomy after diagnosis, 97 percent were alive at five years and 92 percent were free of disease after five years.

What physical and emotional factors are involved when having a double mastectomy?

Many people will experience fear, depression and anxiety about their cancer? diagnosis. Other women are excited about new changes and that they’re taking steps to prevent cancer from happening or coming back. Women should recognize their bodies will be different after mastectomy and/or reconstruction. Some women will decide to use long-term breast prosthesis, while others will struggle with limited range of motion in their arms or lymphedema after surgery. In these instances, physical therapy can be helpful. Women may also experience pain after the procedure, which is often controlled with pain medication.